OBJECTIVE: Medical malpractice reform is a high national priority. AHCPR's Conference on Medical Liability recommended "high-risk" behaviors in physician communication as an area for research. This proposal specifically addresses this identified need. We propose to explore issues related to physicians' communication patterns and malpractice risk on two levels. First, we will examine routine aspects of physicians' communication styles that either enhance or undermine the doctor-patient relationship and influence physicians' risk for malpractice claims. Second, we will investigate the relationship between physicians' perceived threat of potential malpractice, reported practice of "defensive-medicine," and their communication patterns. PARTICIPANTS: One-hundred physicians in primary care and surgical specialties in practice in Oregon and Colorado, will participate in the study. An Advisory Board of physicians will recruit physician participants Physicians will be selected based on prior malpractice claims history, 50 with no claims and 50 with two or more claims, stratified for length of time in practice and specialty. METHODS: The study will utilize both quantitative and qualitative methods. For each physician, 10 audiotapes will be recorded during routine office visits, and these audiotapes will form the database for analysis. In addition, information will be gathered directly from physicians to reflect physicians' perceived fear of malpractice, report of "defensive-medicine" practice, attitudes regarding psychosocial aspects of patient care, and job satisfaction. Ten patients per physician will complete exit questionnaires, as will the physicians, on aspects of the visit, such as reason for visit; patient's physical, emotional, and functional status; and satisfaction with the encounter. Quantitative analysis will be based on use of the Roter interactional Analysis System under the supervision of Dr. Debra Roter. Qualitative analysis will utilize the framework and methods of microinteractional analysis under the direction of Dr. Richard Frankel. Results of the quantitative and qualitative analysis will be compared through a series of discussions between the investigators. Statistical methods will include the use of nested MANOVA, nested ANOVA, and discriminant analysis to test the study hypotheses. FUTURE STUDIES: The long-term goal of this study is to apply the analytic results in formulating a continuing medical education (CME) curriculum that specifically targets the "high-risk" communication behaviors found to be most closely associated with increased malpractice risk. Future studies will rigorously test the efficacy of these continuing CME programs in changing physician communication behaviors which, in turn, will improve quality of care and reduce malpractice risk.